ANDERSON, J.: Perdue Farms, Inc. appeals
a Circuit Court order affirming the award of Workers’ Compensation benefits
to Sandra Hargrove. Perdue argues the Circuit Court erred in ruling substantial
evidence supported the finding by the Appellate Panel of the Workers’ Compensation
Commission that Hargrove aggravated or exacerbated a pre-existing condition
during the course of her employment at Perdue. We affirm.

FACTUAL/PROCEDURAL BACKGROUND

Sandra Hargrove is a thirty-six-year-old mother
of two who resides in Dillon, South Carolina. Hargrove began working at Titan
Textile Company, d/b/a Dillon Yarn (Dillon Yarn), as an inspector/packer in
December of 1997. Hargrove’s job at Dillon Yarn required her to remove spools
of yarn from manufacturing machines and visually inspect the spools before placing
them on a metal pole protruding from a pushcart. Once the spool was on the
cart, she would wrap it in plastic and then, using both hands, remove the spool
from the pole and place it in a box located on the pushcart. Hargrove “put
together” fifty or more boxes per day.

A single box can hold any number of spools depending
on the size of the particular spool being manufactured. When the cart was full,
Hargrove would push it to a conveyor belt where she would unload the boxes.
Hargrove testified she made approximately forty or fifty trips per shift to
the conveyor line. Her supervisor at Dillon Yarn, Effie Peele, estimated Hargrove
would “handle somewhere between 600 and 800 tubes of yarn per day.” During
her time at Dillon Yarn, Hargrove’s work schedule consisted of working eight-hour
shifts, seven days in a row, having two or sometimes three days off, and then
working seven more days.

Hargrove stated she never experienced problems with
either of her arms before working at Dillon Yarn. However, about six or seven
months after her employment at Dillon Yarn began, Hargrove started experiencing
problems with her left hand and arm, including swelling and numbness. She did
not seek medical attention or notify her employer when these problems first
started. She testified she would go home after work and soak her hand and arm
and then “it would be all right”—“[t]he pain would go away” and the “swelling
would go down.” According to Hargrove, this swelling would occur “as much as
once a month.”

On March 1, 2000, Hargrove applied for a position
working first shift at Perdue Farms, a chicken processing plant. On the medical
history section of her application, Hargrove was asked if she had ever “had
pain, numbness, swelling in [her] hands, wrists, arms.” Hargrove indicated
that in the past she had problems with “soreness” due to lifting boxes at Dillon
Yarn. She further noted a history of pain and swelling in her hand and wrist.

Prior to accepting an application, Perdue’s practice
is to give the applicant a physical to see if the individual can physically
perform the job. The physical consists of a number of tests specifically tailored
to the demands of the position being sought. Hargrove was given tests to ascertain
her grip strength on both the right and left hands, in addition to other tests
on her hands including the Tinel, Phalen and Finklestein tests. These three
tests check for numbness and tingling in the hands. The Finklestein test involves
physically touching the median nerve to check for tingling.

The Occupational Health Nurse at Perdue, Mary Smith
Sutherland, declared all tests on Hargrove were negative. Nurse Sutherland
explained that Hargrove’s testing indicated she had a strong grip in both hands
and no problem taking any of the tests administered by Perdue.

Hargrove’s grip strength was important because
she was applying for a position in the evisceration department. Nurse Sutherland
stated that, in the evisceration department, employees have to pull skin off
of the chickens that are being processed. She said that, although machines
have already processed the insides of the chickens, employees might have to
“scoop” the remaining entrails from the bird’s insides. Nurse Sutherland professed
the tasks assigned to an employee in the evisceration department involve repetitive
work, “to some degree.”

After Hargrove passed the physical, Perdue hired
her to work in the evisceration department. Hargrove began her employment with
Perdue on March 13, 2000. [1] The first week consisted of
orientation. Nurse Sutherland testified Hargrove worked 25.61 hours her first
week. The first day of her employment consisted of classroom training for the
entire day. On each remaining day of her first week, Hargrove spent four hours
in the classroom and four hours on a training line.Both Nurse Sutherland
and Hargrove testified that new employees could move more slowly on a training
line than on a regular line.

Hargrove worked 23.18 hours her second week. Unlike
the previous week, she did not have any classroom training and spent all of
her time on a regular line, which processed 2,000 to 5,000 chickens each day.
Hargrove stated that although she was on a regular line, she did not move as
fast as other employees. She declared that her job during this week consisted
of pulling the skin off of chickens and removing the remaining entrails from
the processed chickens.

On or around March 16, 2000, having finished her
shift at Perdue, Hargrove informed Peele, her supervisor at Dillon Yarn, that
she was experiencing pain in her left wrist and arm. Hargrove did not tell
Peele she believed the problems with her arm were work-related and Peele did
not ask if they were. According to Peele, this was the first time Hargrove
complained of pain in her hand and arm. Hargrove made similar complaints to
Peele on at least two more occasions, although Peele did not keep a record of
the complaints. Peele indicated Hargrove’s “job was repetitive.”

On March 23, 2000, Hargrove worked her shift at
Perdue. She testified that, after performing her usual job on the evisceration
line for a short time, the line went down and she was instructed to work in
the box room. Her duties there consisted of retrieving the boxes others were
assembling in the room. When her shift was over, Hargrove went to work her
second-shift position at Dillon Yarn.

After clocking in, but before working, Hargrove
noticed a funny feeling in the fingers on her left hand. Hargrove declared
that nothing happened to her hand or arm between the time she left Perdue and
the time she arrived at Dillon Yarn that would explain the problems she began
having.

Hargrove stated she went to Dillon Yarn’s nurse,
Joyce Harmon, and “asked [Harmon] about the funny feeling in [her] fingers.”
Hargrove requested something for pain. The nurse gave Hargrove some Tylenol
and then Hargrove went to work as usual. As she was performing her normal duties,
Hargrove picked up a tube and it fell from her grasp. She testified that after
she dropped the tube she looked down at her left hand and noticed it was swollen.
Hargrove went to her supervisor and asked if she could be excused to go see
a doctor. She was given permission and went to see her family physician, Dr.
Michael Brown, the next day, March 24.

In his medical report, Dr. Brown noted: “Has tenderness
over the extensor surface left hand and also at base of the thumb.” Dr. Brown
x-rayed the hand, placed it in a splint, and prescribed medication. He wrote
Hargrove an excuse from work for a few days.

On March 27, 2000, Hargrove went to the medical
department at Perdue to provide Dr. Brown’s letter excusing her from work.
Nurse Sutherland professed she did not ask Hargrove whether the injury was work-related
because she did not feel Hargrove had worked at Perdue long enough to have experienced
an injury there. Nevertheless, Nurse Sutherland reviewed Hargrove’s file and
sent her to Perdue’s company physician, Dr. Phil Wallace. [2]

Dr. Wallace’s report, dated March 27, 2000, indicates
Hargrove’s left wrist and hand showed “slight swelling.” He diagnosed “probable
mild tendonitis” and modified her activities for two weeks. The report demonstrates
that Dr. Wallace “advised [Hargrove] she probably needs to pick one or the other
job” because he did not “think she [could] physically handle both.” Dr. Wallace
noted, under a section in the report subtitled “ADD,” that he “[t]alked with
Perdue, felt this was not probably W/C, situation where she is using too much
work in both _____.” Regarding this particular notation, the Single Commissioner
concluded:

The report does speak for itself. A.D.D., I believe, based
on reading medical reports stands for addendum. Meaning this is after he talked
with Perdue he added this.

. . . .

Well, he doesn’t say in the addendum [what his opinion is].
He says “talked with Perdue. Felt this was probably [not] W.C. situation where
she’s using too much work in both something. They both agreed to give her”—he
doesn’t say that this—whether this was his. It looks to me like, “talked with
Perdue. Felt this was not probably W.C. like Perdue was saying it wasn’t Workers’
Comp.

Dr. Wallace issued excuses from work, which Hargrove
took to both Dillon Yarn and Perdue.
[3] On Hargrove’s visit to Dillon Yarn, Harmon, the plant nurse, gave
her a long-term disability form to complete. Hargrove testified she completed
the form and sent it to Dr. Wallace. Harmon stated she talked to Dr. Wallace
and received the disability form back from him, which indicated Hargrove’s problems
with her arm were work-related. In response to the question on the form whether
the condition was “due to injury or sickness arising out of patient’s employment,”
Dr. Wallace checked the box after “Yes.”

On April 5, 2000, after noting Hargrove was continuing
to have pain and limitation of movement in her wrist, Dr. Wallace referred her
to Dr. Dwight Jacobus. Dr. Jacobus, an orthopedic surgeon, is one of Perdue’s
approved doctors for injuries that are work-related. Dr. Jacobus first saw
Hargrove on April 7, 2000. He testified that his “initial impression, after
[he] took a history and physical, was that of a possible carpal tunnel syndrome
as it related to her left upper extremity.” Dr. Jacobus saw Hargrove on at
least four occasions and performed a number of tests and diagnostic studies
to determine the root cause of her problems. Dr. Jacobus noted Hargrove continued
to experience pain and swelling in her left hand. In a medical record dated
May 15, 2000, Dr. Jacobus stated: “I still find no specific clinical abnormality
other than some changes that possibly might represent an early reflex sympathetic
dystrophy. I think a 2nd opinion is important and I have convinced her of that.”

On January 18, 2001, Dr. Jacobus wrote a letter
to Hargrove’s attorney which declared: “It would be my opinion that the symptoms
related to the left upper extremity were most probably caused and aggravated
by repetitive activities related to her work.” In a later deposition, Dr. Jacobus
reaffirmed this opinion.In fact, he specifically opined that Hargrove’s
(1) “long-term repetitious activities” at Dillon Yarn “would have been the activities
that instituted the changes leading to the diagnosis or at least the symptoms
of carpal tunnel syndrome”; and (2) “secondary job responsibilities of stripping
chicken skin” at Perdue “would therefore possibly . . . exacerbate the symptoms
that were instituted by the initial employee responsibilities.”

Because Hargrove was still complaining of pain
and discomfort, Dr. Jacobus felt it prudent to seek a second opinion. Thus,
Hargrove was referred to Dr. Robert W. Moore, a physician in Florence, who specializes
in upper extremity problems. Dr. Moore diagnosed Hargrove with reflex
sympathetic dystrophy in her left hand. He suggested that Hargrove participate
in pain management, as well as hand therapy and several other treatments. A
series of epidural blocks was performed. Hargrove stated these treatments were
not helpful.

Responding to a letter from Hargrove’s attorney,
Dr. Moore stated in a letter dated January 3, 2001, that it was his “opinion
that [Hargrove’s] problem was not caused by the repetitive activities she performed
at Dillon Yarn.” Unable to make much progress towards Hargrove’s improvement,
Dr. Moore referred Hargrove to Dr. James A. Nunley at the Duke University Medical
Center.Dr. Nunley agreed that it “looks like she does in fact have
reflex sympathetic dystrophy.” He noted she “shows the skin changes, the swelling.”
Dr. Nunley suggested Hargrove be referred to Dr. L. Andrew Koman at Bowman Gray
Medical School Reflex Sympathetic Dystrophy Clinic. Hargrove testified she
did not go to Bowman Gray.

On July 19, 2000, Hargrove filed a Form 50 seeking
Workers’ Compensation benefits against Dillon Yarn alleging repetitive trauma
as the cause of her injuries. Hargrove asserted that “[d]ue to injury, the
claimant is in need of . . . medical examination and treatment for carpal tunnel
syndrome.” Dillon Yarn denied Hargrove was entitled to benefits. Dillon Yarn
then moved to add Perdue as a co-defendant. Perdue was joined as a party by
order dated December 14, 2001. Both Dillon Yarn and Perdue claimed the injuries,
if work-related, happened when Hargrove was working for the other.

In her order, the Single Commissioner found the
following facts:

1. Claimant sustained compensable injuries by accident
arising out of and in the course of her employment on March 23, 2000 with both
employers.

4. The last date of injurious exposure occurred while the
employment relationship existed concurrently.

5. It would be unfair to have one employer accept 100%
liability under a theory of last date of injurious exposure when the difference
in the last work date—not employment date—was only a matter of hours and included
a weekend. Consideration is given also to the work schedule and how it may
have figured into dates worked.

The Commissioner concluded: “Pursuant to Section
42-1-160, claimant sustained compensable injuries by accident on March 23, 2000
with both employers.” The Commissioner ruled that Hargrove was entitled to
temporary total disability as well as payment of medical expenses, to be split
evenly between the employers.

Both employers appealed this decision to an Appellate
Panel of the South Carolina Workers’ Compensation Commission (the Appellate
Panel). The Appellate Panel issued an order unanimously affirming the ruling
of the Single Commissioner in its entirety:

After careful review in the instant case, the Appellate Panel
has determined that all of the Hearing Commissioner’s Findings of Fact and Rulings
of Law are correct as stated. We find that such Findings of Fact and Conclusions
of Law are hereby included in this Order by reference . . . . Accordingly,
the Findings of Fact and Conclusions of Law set forth in the single commissioner’s
Order shall become, and hereby are, the law of the case; and, therefore, the
Order is sustained in its entirety.

The employers appealed the Appellate Panel’s decision
to the Circuit Court. The Circuit Court issued a form order affirming the decision.
Specifically, the Circuit Court found: “There is substantial evidence to support
the Commission’s order and therefore it is affirmed.”Perdue appealed
the Circuit Court’s order to this Court. [4]

The substantial evidence rule of the APA governs
the standard of review in a Workers’ Compensation decision. Frame, 357
S.C. at 527, 593 S.E.2d at 494; Corbin v. Kohler Co., 351 S.C. 613, 571
S.E.2d 92 (Ct. App. 2002). This Court’s review is limited to deciding whether
the Commission’s decision is unsupported by substantial evidence or is controlled
by some error of law. SeeGibson, 338 S.C. at 517, 526 S.E.2d
at 728-29; see also Lyles v. Quantum Chem. Co. (Emery), 315 S.C. 440,
434 S.E.2d 292 (Ct. App. 1993) (noting that in reviewing decision of Workers’
Compensation Commission, Court of Appeals will not set aside its findings unless
they are not supported by substantial evidence or they are controlled by error
of law).

Substantial evidence is not a mere scintilla of
evidence, nor the evidence viewed blindly from one side of the case, but is
evidence which, considering the record as a whole, would allow reasonable minds
to reach the conclusion the administrative agency reached in order to justify
its action. Etheredge v. Monsanto Co., 349 S.C. 451, 562 S.E.2d 679
(Ct. App. 2002); Broughton v. South of the Border, 336 S.C. 488, 520
S.E.2d 634 (Ct. App. 1999). The Appellate Panel is the ultimate fact finder
in Workers’ Compensation cases and is not bound by the Single Commissioner’s
findings of fact. Gibson, 338 S.C. at 517, 526 S.E.2d at 729; Muir
v. C.R. Bard, Inc., 336 S.C. 266, 519 S.E.2d 583 (Ct. App. 1999). The final
determination of witness credibility and the weight to be accorded evidence
is reserved to the Appellate Panel. SeeShealy v. Aiken County,
341 S.C. 448, 535 S.E.2d 438 (2000); Parsons v. Georgetown Steel, 318
S.C. 63, 456 S.E.2d 366 (1995); Gibson, 338 S.C. at 517, 526 S.E.2d at
729. The possibility of drawing two inconsistent conclusions from the evidence
does not prevent an administrative agency’s findings from being supported by
substantial evidence. Sharpe v. Case Produce, Inc., 336 S.C. 154, 519
S.E.2d 102 (1999); Muir, 336 S.C. at 282, 519 S.E.2d at 591. Where there
are conflicts in the evidence over a factual issue, the findings of the Appellate
Panel are conclusive. Etheredge, 349 S.C. at 455, 562 S.E.2d at 681.

The findings of an administrative agency are presumed
correct and will be set aside only if unsupported by substantial evidence.
Anderson v. Baptist Med. Ctr., 343 S.C. 487, 541 S.E.2d 526 (2001); Hicks
v. Piedmont Cold Storage, Inc., 335 S.C. 46, 515 S.E.2d 532 (1999). It
is not within our province to reverse findings of the Appellate Panel which
are supported by substantial evidence. Broughton, 336 S.C. at 496, 520
S.E.2d at 637. The appellate court is prohibited from overturning findings
of fact of the Appellate Panel, unless there is no reasonable probability the
facts could be as related by the witness upon whose testimony the finding was
based. Etheredge, 349 S.C. at 455-56, 562 S.E.2d at 681.

In the current case, after “careful review,” the
Appellate Panel found “that all of the Hearing Commissioner’s Findings of Fact
and Rulings of Law [were] correct as stated.” Thus, the Appellate Panel adopted
the Single Commissioner’s findings of fact and rulings of law by reference into
its final order as it is entitled to do under sections 1-23-350 and 42-17-40
of the South Carolina Code. See S.C. Code Ann. §§ 1-23-350 (1986) &
42-17-40 (Supp. 2003); see alsoEaddy v. Smurfit-Stone Container Corp.,
355 S.C. 154, 584 S.E.2d 390 (Ct. App. 2003) (interpreting these statutory provisions
and concluding the Appellate Panel meets the requirements contained therein
when it incorporates a Single Commissioner’s findings of fact and rulings of
law by reference into its order).

LAW/ANALYSIS

Perdue’s sole argument on appeal is that
the Circuit Court erred in finding the Appellate Panel’s decision was supported
by substantial evidence. We disagree.

I. Pee v. AVM

Perdue claims Hargrove did not attribute
her injury to her work at Perdue. Perdue contends Hargrove “was able to identify
a specific incident on March 23, 2000 at Dillon Yarn which caused an acute aggravation
of her underlying condition.”However, as Perdue acknowledges, it is
not necessary for a claimant to identify a specific precipitating event in order
for the claimant to be entitled to benefits. Our Supreme Court addressed this
issue in Pee v. AVM, Inc., 352 S.C. 167, 573 S.E.2d 785 (2002):

Employer contends a repetitive trauma injury does not qualify
as an “injury by accident” because the cause of the injury is not unexpected
and the injury lacks definiteness of time. . . . .

. . . .

As we more recently stated, “in determining whether
something constitutes an injury by accident the focus is not on some specific
event, but rather on the injury itself.” Stokes v. First Nat’l Bank,
306 S.C. 46, 50, 410 S.E.2d 248, 250 (1991). Further, an injury is unexpected,
bringing it within the category of accident, if the worker did not intend it
or expect it would result from what he was doing. Colvin [v. E.I. DuPont
De Nemours Co.], 227 S.C. at 468-69, 88 S.E.2d at 582 (emphasis added).
Therefore, if an injury is unexpected from the worker’s point of view, it qualifies
as an injury by accident. Here, there is no evidence Claimant intended or expected
to be injured as a result of her repetitive work activity.

Employer’s contention that the cause of the injury
must be unexpected is incorrect. Under South Carolina law, if the injury itself
is unexpected, it is compensable as an injury by accident.

. . . .

Definiteness of time, while relevant to proving causation,
is not required to prove an injury qualifies as an injury by accident. For instance,
in Sturkie v. Ballenger Corp., 268 S.C. 536, 235 S.E.2d 120 (1977), we
found the claimant’s emphysema, which developed gradually, was caused by repeated
exposure to high humidity and dust on the job and was therefore compensable
as an injury by accident. Similarly, in Stokes, supra, we found
a psychological disorder which developed over a period of months compensable
as an injury by accident.

. . . .

Here, it is uncontested that Claimant’s carpal tunnel syndrome
was caused by her work activities. The lack of a definite time of injury is
therefore not dispositive.

Pee, 352 S.C. at 170-72, 573 S.E.2d at 787-88
(footnote omitted). Whether Hargrove could identify a precipitating event is
irrelevant in determining if she is entitled to benefits.

Perdue maintains Hargrove exonerated the company
when she stated that nothing unusual happened to her arm while she was working
there and that she never experienced pain and swelling in her hand after working
at Perdue. Yet, this testimony does not provide a full account of the evidence
presented on the issue. Hargrove testified that on March 23, 2000, after working
a full shift at Perdue, she went to her second-shift job at Dillon Yarn. She
declared that after she clocked in, but before beginning her shift, she began
experiencing a funny feeling in the fingers of her left hand. Furthermore,
her supervisor at Dillon Yarn professed Hargrove never complained about experiencing
problems with her arms or hands prior to her beginning the job at Perdue. Thus,
the evidence clearly shows Hargrove had problems with her left hand and arm
after working at Perdue.

Perdue gives credence to the fact that Hargrove
did not work full time her first two weeks at Perdue. Hargrove worked 25.61
hours her first week at Perdue and 23.18 hours the second week. Although the
entire first day consisted of classroom training, for the remainder of her days
the first week, Hargrove spent four hours in class and four hours performing
her normal job, which consisted of pulling the skin off of chickens and removing
their entrails. Hargrove testified she spent the majority of her time the second
week on a regular line, which processed anywhere from 2,000 to 5,000 chickens
per day. Furthermore, Dr. Jacobus concluded Hargrove’s “long-term repetitious
activities” at Dillon Yarn caused the carpal tunnel syndrome and her job at
Perdue “possibly . . . exacerbate[d]” the problems. Concomitantly, there is
substantial evidence in the record that Hargrove’s activities while working
for Perdue exacerbated her condition.

II. Dr. Jacobus

After providing a summary of the evidence presented,
the Single Commissioner made specific findings of fact, including that Hargrove’s
employment with Dillon Yarn caused her carpal tunnel syndrome and her employment
with Perdue exacerbated the condition. Perdue avers the Single Commissioner
misinterpreted Dr. Jacobus’ testimony. Specifically, Perdue asserts the Single
Commissioner erred when she noted in her order that Dr. Jacobus “stated that
both jobs would have exacerbated her problem.”

The disputed testimony arose as a result of a hypothetical
question posed by Hargrove’s attorney. The question followed the chain of events
in Hargrove’s case, but inaccurately suggested Hargrove spent one entire week
in orientation followed by two weeks of performing her normal job. The attorney
then asked Dr. Jacobus if he had an opinion as to which job would most likely
be the cause of Hargrove’s problem. Dr. Jacobus responded:

It would therefore be my opinion that the long-term repetitious
activities, as I believe you related with her first job activities would have
been the activities that instituted the changes leading to the diagnosis or
at least the symptoms of carpal tunnel syndrome. The secondary job responsibilities
of stripping chicken skin, as I perceive that to be, would therefore possibly
exacerbate—exacerbate the symptoms that were instituted by the initial employee
responsibilities.

This was not the first or only time Dr. Jacobus indicated
he considered Hargrove’s injuries to be work-related. In a letter dated January
18, 2001, Dr. Jacobus stated: “It would be my opinion that the symptoms related
to the left upper extremity were most probably caused and aggravated by repetitive
activities related to her work.”

“If a medical expert is unwilling to state with certainty
a connection between an accident and an injury, the ‘expression of a cautious
opinion’ may support an award if there are facts outside the medical testimony
that also support an award.” Tiller, 334 S.C. at 340, 513 S.E.2d at
846. Thus, if medical expert testimony is not solely relied upon to establish
causation, the fact finder must look to the facts and circumstances of the case.
Id. at 341, 513 S.E.2d at 846. Proof that a claimant sustained an injury
may be established by circumstantial and direct evidence where circumstances
lead an unprejudiced mind to reasonably infer the injury was caused by the accident.
Id. at 341, 513 S.E.2d at 846-47. However, such evidence need not reach
such a degree of certainty as to exclude every reasonable or possible conclusion
other than that reached by the Commission. Id. at 341, 513 S.E.2d at
847.

Although medical testimony is entitled to great respect,
the fact finder may disregard it if there is other competent evidence in the
record. SeeTiller, 334 S.C. at 340, 513 S.E.2d at 846 (stating
that medical testimony should not be held conclusive irrespective of other evidence).
In deciding whether substantial evidence supports a finding of causation, it
is appropriate to consider both the lay and expert evidence. Sharpe,
336 S.C. at 161, 519 S.E.2d at 106.

Neither the Single Commissioner nor the Appellate
Panel erred in relying on the testimony of Dr. Jacobus. The subtle differences
posed in the hypothetical question, compared to the actual events, merely affect
the weight of the doctor’s testimony and not its validity.

III. Aggravation
of Pre-Existing Condition

Perdue asserts “Dr. Jacobus said nothing about
any permanent injury being caused by her employment at Perdue. He only speculated
about an aggravation of symptoms.”

A work-related accident which aggravates
or accelerates a pre-existing condition, infirmity, or disease is compensable.
Brown v. R.L. Jordan Oil Co., 291 S.C. 272, 353 S.E.2d 280 (1987); Sturkie
v. Ballenger Corp., 268 S.C. 536, 235 S.E.2d 120 (1977); Mullinax v.
Winn-Dixie Stores, Inc., 318 S.C. 431, 458 S.E.2d 76 (Ct. App. 1995). A
condition is compensable unless it is due solely to the natural progression
of a pre-existing condition. Mullinax, 318 S.C. at 437, 458 S.E.2d at
80. It is no defense that the accident, standing alone, would not have caused
the claimant’s condition, because the employer takes the employee as it finds
him or her. Id. “[A]ggravation of a pre-existing condition is compensable
where disability is continued for a longer time, even though no disability would
normally have resulted from the injury alone, or even if the aggravation would
have caused no injury to an employee who was not afflicted with the condition.”
Id. (internal quotations omitted).

When a pre-existing condition or disease is accelerated
or aggravated by injury or accident “arising out of and in the course of the
employment,” the resulting disability is a compensable injury. Brown,
291 S.C. at 275, 353 S.E.2d at 282; Arnold v. Benjamin Booth Co., 257
S.C. 337, 185 S.E.2d 830 (1971); see alsoSturkie, 268 S.C. at
541, 235 S.E.2d at 122 (exacerbation of pre-existing disease or injury arising
out of or in course of employment is compensable).

The right of a claimant to compensation for aggravation
of a pre-existing condition arises only where there is a dormant condition which
has produced no disability but which becomes disabling by reason of the aggravating
injury. Hines v. Pacific Mills, 214 S.C. 125, 51 S.E.2d 383 (1949).
A determination of whether a claimant’s condition was accelerated or aggravated
by an accidental injury is a factual matter for the Appellate Panel. Brown,
291 S.C. at 275, 353 S.E.2d at 282. Where there is a conflict in the evidence
from the same or different witnesses, the Panel’s findings of fact may not be
set aside. Id.

IV. Substantial
Evidence to Support Decision of Appellate Panel

After thoroughly reviewing the record, we find
substantial evidence supports the Appellate Panel’s ruling. Hargrove’s supervisor
at Dillon Yarn testified Hargrove never complained about problems with her hand
or arm prior to beginning her employment with Perdue. Although Hargrove experienced
problems with her hand and arm before working at Perdue, she said she would
go home after work and soak her hand and arm and then “it would be all right”—“[t]he
pain would go away” and the “swelling would go down.”

On March 1, 2000, Hargrove applied for her position
at Perdue. At that time, she was given a physical specifically designed for
the rigors of the job for which she was applying. Several of the tests were
aimed at detecting problems with her arms and/or hands. Nurse Sutherland testified
Hargrove passed all the tests with no problems and possessed a strong grip in
both hands.

On March 16, 2000, after completing her shift at
Perdue, Hargrove complained to her supervisor at Dillon Yarn for the first time
that her hand and arm were giving her problems. On March 23, 2000, Hargrove
finished her shift at Perdue and was clocking in at Dillon Yarn when she noticed
a funny feeling in the fingers on her left hand. At the time this “funny feeling”
began, Hargrove had not yet started her work duties for the day at Dillon Yarn.
Later that night, Hargrove’s arm became swollen and she asked if she could be
excused to go see a doctor.

On March 27, 2000, Hargrove was sent to Dr. Wallace,
who opined that he did not “think she [could] physically handle both [jobs].”
Dr. Wallace referred Hargrove to Dr. Jacobus, who expressed the opinion that
her condition was indeed work-related.

In deciding whether substantial evidence exists, it is appropriate
to consider both the lay and expert evidence. SeeSharpe v. Case
Produce, Inc., 336 S.C. 154, 519 S.E.2d 102 (1999). Although there is evidence
from which the Appellate Panel could have gone the other way, there is clearly
evidence which would allow reasonable minds to reach the conclusion the Panel
reached. Substantial evidence supports the Appellate Panel’s finding that Hargrove’s
work at Perdue aggravated or exacerbated her pre-existing condition.

CONCLUSION

We find substantial evidence supports the
Appellate Panel’s order. The Circuit Court did not err in affirming this decision.
Accordingly, the Circuit Court’s ruling is

AFFIRMED.

HUFF, J., concurs.

KITTREDGE, J., dissents in a separate opinion.

KITTREDGE, J.: I respectfully dissent.
This appeal presents the question of whether substantial evidence supports the
Commission’s finding that Sandra Hargrove’s nine-day tenure at Perdue Farms
– comprised entirely of orientation, training and light work – exacerbated a
condition caused by her long-time employment at Dillon Yarn. Having carefully
considered the record and applicable standard of review, I would reverse based
on my conclusion that the Commission’s finding that Hargrove aggravated her
pre-existing condition in the course of her brief employment at Perdue Farms
is not supported by substantial evidence. In my judgment, the Commission’s
decision rests solely on speculation.

Hargrove’s condition undisputedly
originated from her work at Dillon Yarn, where she was employed periodically
from 1992 through March 23, 2000. Neither Hargrove nor Dillon Yarn dispute
the Commission’s finding that Hargrove’s condition was caused by her employment
with Dillon Yarn. Thus, this finding is the law of the case. SeeUnisun Ins. v. Hawkins, 342 S.C. 537, 544, 537 S.E.2d 559, 563 (Ct.
App. 2000) (stating an unappealed ruling is the law of the case which the appellate
court must assume was correct). Hargrove worked eight-hour shifts at Dillon
Yarn, during which she would lift, bag, and box between 600 and 800 spools of
yarn from a texturing machine.

On March 13, 2000, Hargrove began her brief tenure
with Perdue Farms, while continuing to work full-time at Dillon Yarn. Hargrove
worked only 25.61 hours in her first of two weeks as an employee of Perdue Farms.
Her first day of employment at Perdue Farms was entirely devoted to orientation
and classroom training. On the remaining four days of her first week, Hargrove
spent four hours each day receiving additional classroom training and four hours
each day on a special production line used to train new employees. The training
line moved at half the speed of the normal production lines. Hargrove would
rotate between functions throughout the day rather than doing one thing repetitively
all day. According to Hargrove, the work using her hands did not involve “any
real effort.”

During Hargrove’s second week at Perdue Farms,
she worked 23.18 hours over a four-day period. She continued to work at a training
line until fourth day, March 23, 2000, when the line went down. Although she
“didn’t do much that day” at Perdue Farms, Hargrove did help move empty boxes.
Later that same day, Hargrove went to her job at Dillon Yarn, where she complained
to her supervisor that her left hand was “swollen,” “feeling funny,” and had
“started hurting.” The supervisor sent her to the plant’s nurse, who gave Hargrove
Tylenol. Hargrove completed her shift, but later went to a physician for additional
treatment. Upon the physician’s recommendation, Hargrove did not return to
work at Dillon Yarn or Perdue Farms. She later brought the present action,
seeking workers’ compensation benefits from Dillon Yarn. Dillon Yarn joined
Perdue Farms as a defendant.

In deposition testimony, the following exchange
occurred between Dillon Yarn’s counsel and Hargrove:

[Counsel]: Did the fingers on your left hand feel funny
while you were working at Perdue [on March 23, 2000]?

[Hargrove]: No sir.

When Dillon Yarn’s counsel asked Hargrove whether
she had “ever felt that funny feeling before,” Hargrove responded, “The only
time I felt that is like when I worked hard at Dillon Yarn.” When questioned
as to whether she had any knowledge of an incident or accident at Perdue Farms
related to her condition, she responded, “No, sir.”

Dr. Dwight Jacobus, a general orthopedic
surgeon who served as one of Hargrove’s treating physicians, provided additional
deposition testimony. During the deposition, a hypothetical question posed
to Dr. Jacobus solicited his opinion regarding which of Hargrove’s jobs had
caused her condition, or whether the condition was caused by “a combination
of the two” jobs. In pertinent part, the hypothetical was premised on the false
assumption that Hargrove’s employment at Perdue Farms consisted of “one week
of training and two weeks of actually performing the job.” Jacobus opined that
the long-term, repetitive nature of her job at Dillon Yarn “would have been
the activities that instituted the changes leading to the diagnosis or at least
the symptoms of carpal tunnel syndrome.” He added that the “secondary job responsibilities
of stripping chicken [at Perdue Farms], as I perceive that to be, would therefore
possibly exacerbate … symptoms that were instituted by the initial responsibilities
[at Dillon Yarn.]” (emphasis added).

The order of the single commissioner erroneously
stated that Dr. Jacobus opined that Hargrove’s “left upper extremity problems
were most probably caused and aggravated by her work … [and] … both jobs
would have exacerbated her problem.” (emphasis added). The commissioner concluded
that Hargrove’s work at Perdue exacerbated her pre-existing condition. Consequently,
the commissioner ordered Dillon Yarn and Perdue Farms to each pay one-half of
the temporary total disability benefits awarded Hargrove, as well as charges
for all past, present, and continuing medical expenses related to the injury.
An appellate panel of the Commission affirmed, adopting all of the single commissioner’s
findings. The circuit court affirmed the Commission.

I recognize that in workers’ compensation cases,
compensation may be awarded although “a medical expert is unwilling to state
with certainty a connection between an accident and an injury … ‘if there are
facts outside the medical testimony that also support an award.’” Tiller
v. Nat’l Health Care Ctr., 334 S.C. 333, 340, 513 S.E.2d 843, 846 (1999),
citing Grice v. Dickerson, Inc., 241 S.C. 225, 127 S.E.2d 722 (1962).
This court applied this principle in Muir v. C.R. Bard, Inc., 336 S.C.
266, 287, 519 S.E.2d 583, 594 (Ct. App. 1999) (“If a medical expert is unwilling
to state with certainty a connection between an accident and an injury, the
‘expression of a cautious opinion’ may support an award if there are facts outside
the medical testimony that also support an award”). Here, the Commission relied
solely on the testimony of Dr. Jacobus in finding that Hargrove’s employment
at Perdue Farms exacerbated her condition. The Commission adopted the single
commissioner’s finding that Dr. Jacobus opined that Hargrove’s condition was
“most probably” exacerbated by both of her jobs. Dr. Jacobus rendered no such
opinion, as he only testified that Hargrove’s work at Perdue Farms “possibly
exacerbate[d]” symptoms of the condition caused by her work at Dillon Yarn.
At best, Dr. Jacobus provided an “expression of a cautious opinion” with respect
to the relationship between Hargrove’s condition and her work at Perdue Farms.
There is no additional evidence, lay or otherwise, supporting an award against
Perdue Farms. In fact, Hargrove’s testimony refutes any suggestion or inference
of a connection between her injury and her nine-day employment at Perdue Farms,
which she conceded did not involve “any real effort.” “Workers’ compensation
awards must not be based on surmise, conjecture or speculation.” Tiller,
334 S.C. at 339, 513 S.E.2d at 845.

I reach this conclusion fully cognizant of the
deferential substantial evidence standard of review applicable to appeals from
the Commission. Consistent with this deferential standard of review, an appellate
court must nevertheless ensure the record contains some evidence beyond a mere
scintilla which, considering the record as a whole, would allow reasonable minds
to concur in the conclusion reached by the Commission. SeeLark v.
Bi-Lo, Inc., 276 S.C. 130, 135, 276 S.E.2d 304, 306 (1981) (holding that
an appellate court’s review of appeals from the Commission is limited to deciding
whether the Commission’s decision is unsupported by substantial evidence or
is controlled by some error of law); Broughton v. South of the Border,
336 S.C. 488, 496, 520 S.E.2d 634, 637 (Ct. App. 1999) (“Substantial evidence
is not a mere scintilla of evidence, nor the evidence viewed blindly from one
side of the case, but is evidence which, considering the record as a whole,
would allow reasonable minds to reach the conclusion the administrative agency
reached in order to justify its action”). Mindful of this deferential standard
of review, the record in my judgment yields, at best, a mere scintilla of evidence
to support the Commission’s finding that Hargrove aggravated her pre-existing
condition in the course of her brief employment at Perdue Farms. I would reverse.

[1] Hargrove testified she was seeking a first shift job that would enable
her to go back to school in the evenings. However, she was working both jobs
when the problems underlying this appeal occurred.

[2] Dr. Wallace is the company doctor for both Perdue and Dillon Yarn.

[3] Hargrove did not return to work for either employer following her
first visit with Dr. Wallace.

[4] Dillon Yarn did not appeal this final order and, in fact, participates
in this appeal as a Respondent.